MEDICARE: SOUTH TEXAS PAIN & HEALTH MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	J0170	TX
2	208VP0014X	Interventional Pain Medicine Physician	J0170	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0045EE	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1730263955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS PAIN & HEALTH MANAGEMENT

Provider Business Mailing Address
First Line	:	PO BOX 1674
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77487-1674
Country	:	US
Telephone Number	:	281-238-5480
Fax Number	:	832-595-9796

Provider Business Practice Location Address
First Line	:	1601 MAIN ST STE 407
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3244
Country	:	US
Telephone Number	:	281-238-5480
Fax Number	:	832-595-9796

Authorized Official
Title or Position	:	DIRECTOR
Name	:	WOLE EMMANUEL OLADUTE
Credential	:	M.D.,
Telephone Number	:	281-238-5480

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/11/2025

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Directions to “SOUTH TEXAS PAIN & HEALTH MANAGEMENT ” Practice Location

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